C09993937 / invoice 10000

06/03/2026 Presenting Complaint:
- Recheck for inappetence, lethargy and pyrexia.

Hx:
- Seen on Wednesday (04/03/2026) for similar signs.
- Ate well Wednesday evening after consult (minced meat, chicken).
- Poor appetite yesterday and today. Not eating this morning.
- Drinking normally.
- Diarrhoea is improving, still present but firmer. Stool is still very green.
- No vomiting.
- Quieter than usual but will still play for short periods.
- Last ate properly on Monday (02/03/2026) from owner's hand.
- History of pyogranulomatous hepatitis diagnosed 3 years ago via biopsy, suspected infectious origin.

Diet:
- Offered puree, peas, dry food, minced meat and chicken. Not eating.

Medication:
- On Amoxicillin since Monday.
- On Metronidazole and Enrofloxacin since Wednesday.
- Received Cerenia this morning.
- On prednisone for pollen allergy.

Parasite and Vaccination Preventive:
- Not discussed.

PEx:
Temperament: Quiet but calm and alert.
BCS:
MM: Tacky, CRT: 1-2 sec
Mouth: NAD
eyes: NAD
ears: NAD
nose: NAD
Cardiovascular: HR: , PR Murmur: No
Respiratory: RR = , lung sounds are normal
Lymph nodes: NAD
Abdominal Palpation: Mild discomfort on palpation of the mid-cranial abdomen. Gut sounds are very quiet (ileus).
Skin/Coat: Mildly dehydrated.
Musculoskeletal: NAD
Genitalia: NAD
Rectal temperature: 40.2
Other Issues:

Laboratory results:
- Lepto test negative (from previous consult).
- Bloods taken today and sent to external lab, marked as urgent.

Assessment:
- Persistent pyrexia, not responsive to 48 hours of antibiotic therapy.
- Inappetence.
- Lethargy.
- Mild dehydration.
- Abdominal pain (mid-cranial).
- Ileus.
- The persistent fever despite broad-spectrum antibiotics is concerning. The lack of improvement suggests the current treatment may not be targeting the underlying cause, or more time is needed. Dehydration is likely secondary to fever and reduced intake. Abdominal pain and ileus are consistent with gastrointestinal upset and systemic illness. Differential diagnoses are broad but given history, a relapse/progression of her pyogranulomatous hepatitis is suspected. An infectious cause is still most likely.

Plan:
- Continue Amoxicillin, Metronidazole and Enrofloxacin as directed.
- Dispense more Amoxicillin.
- Dispense Cerenia tablets. Has some pain-relieving properties for the gut.
- Dispense Lectade oral electrolyte solution to mix with water to improve hydration.
- Dispense 2 tins of Hills A/D diet to try and encourage eating. Can be made into a slurry for syringe feeding.
- Write script for Ursodeoxycholic acid. To be filled at a compounding pharmacy or online (e.g. Pet Chemist).
- Check if Denamarin has arrived.
- Blood results expected tonight or tomorrow morning. Dr Matt will call owner with results tomorrow.
- Referral written for SASH internal medicine for specialist ultrasound and further investigation if she deteriorates or does not improve. Owner advised to take her to SASH emergency over the weekend if she gets worse. SASH will be notified that she may present.
- Advised owner that husband can call for an explanation of the plan.

Consult Summary:
- Recheck for pyrexia and inappetence.
- Temp 40.2C, no improvement on antibiotics.
- Mildly dehydrated, tacky gums.
- Discomfort on abdominal palpation, quiet gut sounds.
- Bloods sent to lab, results pending.
- Dispensed further antibiotics, anti-nausea medication, electrolytes and high-calorie food.
- Script for Ursodeoxycholic acid provided.
- Referral to SASH for specialist workup if no improvement.